Meta‐analysis of surgical treatment for postinfarction left ventricular free‐wall rupture

Abstract

Background Left ventricular free‐wall rupture (LVFWR) is one of the most lethal complications after acute myocardial infarction (AMI). The optimal therapeutic strategy is controversial. The current meta‐analysis sought to examine the outcome of patients surgically treated for post‐AMI LVFWR. Methods A comprehensive literature review was performed to identify articles reporting outcomes of subjects who underwent LVFWR surgical repair. The primary endpoint was operative mortality. A meta‐analysis was performed to assess the associations of predefined variables of interest and clinical prognosis. Results Of the 3132 retrieved articles, 11 nonrandomized studies, enrolling a total of 363 patients, fulfilled the inclusion criteria and were included in this analysis. The mean age of patients was 68 years. The operative mortality rate was 32% (n = 115). Meta‐analysis revealed reduced operative risk in patients with oozing type rupture, as compared to blowout type (risk ratios [RR]: 0.47; 95% confidence interval [CI]: 0.33–0.67; p < .0001); RR was also significantly reduced in subjects in whom LVFWR was treated with sutureless technique, as compared to those undergoing sutured repair (RR: 0.59; 95% CI: 0.41–0.83; p = .002). Increased risk of operative mortality was demonstrated in patients who required postoperative extracorporeal membrane oxygenation (ECMO) support (RR: 2.39; 95% CI: 1.59–3.60; p < .0001). Conclusions Surgical treatment of postinfarction LVFWR has a high operative mortality rate. Blowout rupture, sutured repair and postoperative ECMO support are factors associated with increased risk of operative mortality.

Complicating Acute Myocardial Infarction. Current Status and Unresolved Targets for Subsequent Research

“…In survivors, sutured PMR must be monitored for early detection of leaks or for aneurysm formation. remains high, reaching 32% [45]. The largest to date meta-analysis by Matteucci et al [45] included 363 patients with FWR who underwent surgery.…”

“…Based on the pathological criteria, FWR can be divided into type I, with a sudden fissure rupture in the myocardium of the time of ischemia < 24 h, type II, with an erosion site in the infarct zone showing a gradual worsening of the tear and type III rupture, associated with early LV aneurysm formation. Clinically, according to the size of FWR and the dynamics of bleeding to the pericardium, FWR can be divided into an oozing type and a blowout type [45].…”

“…In the case of rapidly increasing symptoms, surgery should be preceded by pericardiocentesis. Unfortunately, the mortality rate among patients treated with surgery remains high, reaching 32% [45]. The largest to date meta-analysis by Matteucci et al [45] included 363 patients with FWR who underwent surgery.…”

“…Unfortunately, the mortality rate among patients treated with surgery remains high, reaching 32% [45]. The largest to date meta-analysis by Matteucci et al [45] included 363 patients with FWR who underwent surgery. They revealed a twice-lower operative risk in patients with oozing type rupture, as compared to the blowout type (Figure 3 and Video S1).…”

“…Percutaneous intrapericardial fibrin-glue injection therapy is an alternative therapy for FWR surgery, especially in an oozing FWR type [45]. Hattori et al showed that fibrin glue, inserted into the pericardium, formed fibrin within 1 day, while the glue has degraded within a week [95].…”